Long Head of the Biceps as a Suitable Available Local Tissue Autograft for Superior Capsular Reconstruction: “The Chinese Way”  Achilleas Boutsiadis, M.D., Ph.D., Shiyi Chen, M.D., Ph.D., Chunyan Jiang, M.D., Ph.D., Hubert Lenoir, M.D., Philippe Delsol, Johannes Barth, M.D.  Arthroscopy Techniques  Volume 6, Issue 5, Pages e1559-e1566 (October 2017) DOI: 10.1016/j.eats.2017.06.030 Copyright © 2017 Terms and Conditions

Fig 1 (A) Preoperative imaging evaluation of a patient with a massive rotator cuff tear in the left shoulder. (A1, A2) Anteroposterior and lateral radiographic examination of left shoulder showing lateral extension of acromion (critical shoulder angle, 39°) and decreased acromiohumeral distance less than 6 mm (Hamada stage 2) (arrows). (A3) Coronal view of computed tomography arthrography showing massive retracted (Patte stage III) posterosuperior rotator cuff tear (arrow) in left shoulder. (A4) Sagittal view of same patient's examination showing grade 3 fatty infiltration of supraspinatus muscle (arrow), according to Goutallier classification. (B) Left shoulder setup in beach-chair position (superior view). The possible necessary arthroscopic portals (arrows) are posterior (P), anterior (A), lateral (L), and posterolateral (PL). An anterosuperolateral (AL) portal may be necessary in cases of subscapularis tears. A Neviaser portal may also be used during suture passage to the infraspinatus (asterisk). (C, coracoid; CA, coracoacromial ligament.) (C) Right shoulder showing massive retracted rotator cuff tear, reverse-L type (arrows indicate torn subscapularis and infraspinatus tendons; asterisk indicates torn and retracted supraspinatus tendon tear). (C1) By use of the posterior viewing portal (left shoulder, with patient in beach-chair position), the subscapularis tendon tear with the coexisting comma sign (red comma) is recognized, and the rotator interval and any adhesions are released by use of the arthroscopic shaver from the anterior portal (asterisk indicates middle glenohumeral ligament is released during subscapularis tendon mobilization). (C2) The subscapularis tendon is released from any possible adhesions, and its mobility is controlled by pulling it with a tendon grasper from the anterosuperolateral portal (arrow) (posterior intra-articular viewing portal, left shoulder, inside-the-box repair). (C3) The subscapularis tendon is repaired onto the lesser tuberosity, and the comma sign (red comma) is also restored (white and black arrows show tape and suture used for repair) (posterior intra-articular viewing portal, left shoulder, inside-the-box repair). (HH, humeral head.) Arthroscopy Techniques 2017 6, e1559-e1566DOI: (10.1016/j.eats.2017.06.030) Copyright © 2017 Terms and Conditions

Fig 2 (A) Subacromial view from lateral arthroscopic portal (left shoulder, with patient in beach-chair position) showing massive retracted posterosuperior rotator cuff tear with concomitant tendon delamination. (G, glenoid; HH, humeral head; IS, infraspinatus; LHBT, long head of biceps tendon in good condition; SS, retracted supraspinatus.) (B1) A 5.5-mm absorbable triple-loaded suture anchor (asterisk) is inserted through the lateral portal at the footprint of the supraspinatus tendon onto the greater tuberosity (GT) (posterolateral viewing portal in left shoulder, beach-chair position). (B2) By use of the NeedlePunch suture passer through the lateral portal (arrow), the suture of the inserted anchor is passed through the intact long head of the biceps tendon (LHBT) performing a lasso-loop configuration (posterolateral viewing portal in left shoulder, beach-chair position). (HH, humeral head; RI, rotator interval.) (C) All the sutures of the 5.5-mm triple-loaded anchor are passed through the LHBT with a lasso-loop configuration (posterolateral viewing portal in left shoulder, beach-chair position). The sutures have a distance of approximately 5 mm between them (white and black arrows). (A, acromion; GT, greater tuberosity; HH, humeral head.) (D) The LHBT has been tenotomized distally, sutured (with 3 sutures [asterisks]), and sequentially transferred at the footprint of the supraspinatus (SS) tendon onto the greater tuberosity (GT) acting as the autograft for superior capsular reconstruction (view from lateral portal in left shoulder, beach-chair position). (IS, infraspinatus; RI, rotator interval.) (E) Right shoulder showing the LHBT that was tenotomized distally (black arrow), sutured, and transferred at the footprint of the supraspinatus tendon (white arrow), acting as the autograft for superior capsular reconstruction. Arthroscopy Techniques 2017 6, e1559-e1566DOI: (10.1016/j.eats.2017.06.030) Copyright © 2017 Terms and Conditions

Fig 3 (A) To repair the remaining torn infraspinatus tendon, 1 loaded 4.75-mm SwiveLock (asterisk) has been placed behind the transferred long head of the biceps tendon (LHBT) (posterolateral viewing portal in left shoulder, with patient in beach-chair position). The TigerTape (Arthrex) and the blue suture (black arrow) of the anchor have already been passed through the infraspinatus tendon (IS). A suture lasso device (Banana Lasso) has been inserted through the posterior portal and has penetrated the IS (white arrow) also to retrieve the sutures of the LHBT. (HH, humeral head.) (A1) Suture lasso device (Banana Lasso) introduced from posterior arthroscopic portal (arrow) (left shoulder, with patient in beach-chair position). The arthroscope is placed in the lateral portal to control the placement of the device. (B) The white sutures and the black-and-white sutures (arrow) of the LHBT are passed through the infraspinatus tendon to perform a side-to-side repair later (asterisk indicates 4.75-mm SwiveLock anchor) (posterolateral viewing portal in left shoulder, with patient in beach-chair position). (GT, greater tuberosity.) (B1-B3) The white sutures and the black-and-white sutures (arrows) of the LHBT are tied, and a side-to-side, tension-free marginal repair of the IS with the LHBT is performed. The margins of the LHBT and the IS have been noted (posterolateral viewing portal in left shoulder in B1; lateral viewing portal in left shoulder, with patient in beach-chair position, in B2 and B3). (C) Final construct of superior capsular reconstruction using autologous LHBT, repair of IS by transosseous-equivalent technique (SpeedBridge, white arrow), and finally, side-to-side, tension-free marginal repair of IS with LHBT (black arrow). (C1) Repair of IS by transosseous-equivalent technique (SpeedBridge, white arrow) (lateral viewing portal in left shoulder, with patient in beach-chair position). The transferred LHBT is shown by the black arrow. (C2) Final arthroscopic image of aforementioned repair (C1) using anterosuperolateral viewing portal (left shoulder, with patient in beach-chair position). The margins of the LHBT and the IS have been noted. (C3) Final intra-articular image of repair from posterior portal (the black arrow indicates that after transfer of the LHBT and repair of the IS, a “watertight” construct has also been achieved; the white arrow indicates repair of the subscapularis tendon) (left shoulder, with patient in beach-chair position.) (G, glenoid; HH, humeral head.) Arthroscopy Techniques 2017 6, e1559-e1566DOI: (10.1016/j.eats.2017.06.030) Copyright © 2017 Terms and Conditions

Fig 4 Final construct of superior capsular reconstruction using autologous long head of biceps tendon (LHBT) and repair of infraspinatus and subscapularis tendons by SpeedFix technique (black arrows) in patient's right side. Finally, a side-to-side, tension-free marginal repair of the LHBT with both the infraspinatus and subscapularis tendons is performed (white arrow). The distal part of the LHBT (asterisk) is left free. Arthroscopy Techniques 2017 6, e1559-e1566DOI: (10.1016/j.eats.2017.06.030) Copyright © 2017 Terms and Conditions